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Original Article

JNBS. 2017; 4(3): 99-105

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

Tonguc Demir Berkol; Yasin Hasan Balcioglu; Hasan Mervan Aytac; Simge Seren Kirlooglu; Serkan Islam; Ilker Ozyildirim.

The evidence base data regarding long-term treatment of bipolar disorder (BD) is less than satisfactory. With the first-line rank of lithium and valproate; antipsychotics (AP) and anticonvulsants (AC) considered options for prolonged treatment in remitted bipolar patients. Literature demonstrates various treatment options in remitted patients with different clinical features. The aim of this study to present and assess clinical outcomes of maintenance treatment for BD with various clinical features. In total 186 bipolar patients in remission were enrolled in this study. All the patients were evaluated with SCID-I (Structured Clinical Interview for DSM-IV) ; and lifelong psychiatric comorbidities were determined. Sociodemographical and clinical features, and lifelong pharmacological treatment of the patients were assessed. Semi-structured interview schedules were filled. 71% lithium, 44% AC, 18% AP monotherapies and 23% lithium-AC, 15% lithium-AP, 25% AC-AP combination therapies were used as maintenance treatment. 61% and 62% of the patients were responders of lithium and AC monotherapies respectively. AC and AP combination had the highest response level. The predictors on the probability of treatment response for lithium were being married, non-psychotic, to show seasonal pattern and less severe episodes. Anticonvulsants were effective in males, divorces, suicide attempters, and the patients with predominance of mixed features in periods. Obsessive-compulsive disorder was the most common comorbid diagnosis in study group. Lithium monotherapy was tended to use in prevention, however treatment combinations which contain APs might be effective alternative to monotherapy. Individualized medication ought to be administered for each patient, with the consideration of clinical features and tolerability.

Key words: antipsychotics;bipolar disorder;maintenance;remission

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